Workers' Compensation Claims Examiner

Accountabilities:: Claims Management: Manage a full caseload of California workers' compensation claims from initial notification through investigation, administration, negotiation, and final resolution. Investigation and Compensability: Investigate claims, assess available evidence, determine compensability, and establish appropriate reserves based on claim circumstances and potential exposure. Claim Strategy and Resolution: Develop and implement effective claim handling strategies, monitor case progress, and identify appropriate approaches to achieve timely and fair resolutions. Stakeholder Coordination: Maintain regular communication and coordinate with injured workers, employers, attorneys, medical providers, vocational professionals, and other relevant parties throughout the life of each claim. Medical and Financial Evaluation: Review medical records, wage information, and supporting documentation to assess claim exposure, determine eligibility, and evaluate appropriate benefits. Settlement Negotiation and Litigation: Negotiate settlements and collaborate with defense counsel on litigated claims, supporting effective case management and resolution. Documentation and Systems Management: Maintain complete, accurate, and timely claim records within the claims management system, ensuring all relevant activities and decisions are properly documented. Regulatory Compliance: Ensure all claim handling activities comply with California workers' compensation statutes, regulations, benefit requirements, and applicable internal guidelines. Requirements: Professional Experience: At least five years of experience as a California Workers' Compensation Claims Examiner is required. California Regulatory Knowledge: Strong understanding of California workers' compensation laws, regulations, claims procedures, and benefit administration. Claims Expertise: Demonstrated experience managing indemnity claims and litigated California workers' compensation cases from inception through resolution. Residency: Must currently reside in California. Investigation and Analytical Skills: Ability to evaluate medical records, wage documentation, legal materials, and other evidence to determine compensability and assess claim exposure. Negotiation Skills: Experience negotiating settlements and working effectively with defense counsel and other stakeholders on complex or litigated claims. Communication and Relationship Management: Excellent written and verbal communication skills, with the ability to interact professionally with injured workers, employers, attorneys, medical providers, and other parties. Organization and Time Management: Strong organizational skills and the ability to prioritize competing deadlines while maintaining accurate documentation and managing a full caseload. Independent Working Style: Ability to work autonomously, exercise sound judgment, and maintain productivity in a fully remote environment. Technical Proficiency: Experience using claims management systems and proficiency with Microsoft Office applications. Certification: SIP certification is preferred but not required. Benefits: Compensation: $45–$55 per hour, depending on experience. Work Arrangement: Fully remote position. Healthcare Coverage: Medical, dental, and vision benefits available while on assignment. Retirement: 401(k) benefits available while on assignment. Employment Opportunity: Temporary-to-permanent arrangement, with a strong opportunity for permanent employment based on performance.